Fewer Risks, Lower Costs -- and Healthier Mothers and Babies

DALLAS -- Cesarean sections have reached the highest rate ever in the United States-- nearly one in three births -- and critics say physicians perform them too often, needlessly exposing mothers and babies to major-surgery risks.

With a goal of eliminating unnecessary procedures, leading nursing schools -- including Baylor University Louise Herrington School of Nursing -- are offering a new educational program so that students can progress directly from a bachelor's degree in nursing to a doctorate in nurse-midwifery. The Doctor in Nursing Practice degree (DNP) requires a project applicable to clinical practice rather than a research dissertation.

The first nurses in the country to finish the program will receive their degrees May 14 from Louise Herrington School of Nursing, according to the Accreditation Commission for Midwifery Education.

"Doctors are expert in diagnosis and treatment of illness -- but birth is not a sickness," said Dr. Mary Ann Faucher, associate professor of nursing and program coordinator of the nurse-midwifery program at the Dallas-based nursing school.

"We trust birthing; we trust women's bodies," she said. "The best practice is when midwives collaborate with an obstetrician if there are complications."

Only eight nursing schools in the country offer the DNP in nurse-wifery program, with Baylor's nursing school the only Texas nursing school to offer it, according to the accreditation commission.

Nurse-midwifery focuses on births without unnecessary procedures, and studies show births attended by nurse-midwives have fewer health risks for mothers and babies. While the DNP degree is not new for nursing specialties such as nurse practitioners, it is new for the practice of nurse-midwifery.

While C-sections can save a mother or child's life in case of complication, the World Health Organization and U.S. health agencies say a C-section rate of 15 percent is closer to ideal than the nearly 32 percent -- 1.4 million procedures -- in American hospitals in 2007, the most recent year for which figures are available.

A comparison between physicians and nurse-midwives shows that outcomes of normal vaginal births at between 35 and 43 weeks of pregnancy are equal to or better than births attended by physicians, Faucher said. The study was done with adjustments for medical risks and demographics and published in Obstetrics & Gynecology, the journal of the American College of Obstetricians and Gynecologists.

The comparison shows that births attended by a nurse-midwife had:

 A 33 percent lower risk of neonatal (the first 28 days of life) deaths

 A 19 percent lower risk of infant (the first year of life) mortality

 A 33 percent lower risk of babies with low birth weights.

Nurse-midwives also perform fewer episiotomies, fewer labor inductions and fewer instrumental births -- those done with forceps or vacuum extractors -- than physicians do, Faucher said. While they do not perform operations, they may assist and may prescribe medicine, including pain relievers.

"The million-dollar question is why the United States health care system has not taken advantage of midwifery for women's health," Faucher said. "Costs are less to an insurance company because of fewer cesareans, lower rates of technological intervention, shorter length of stay and lower payroll."

All of which translates to lower cost for the patient, she said.

"Midwifery is all about choices," Faucher said. "Childbirth for almost 95 percent of women is a healthy life event."

But misconceptions still exist about midwifery, she said.

One is that midwife-assisted births usually occur in homes. In reality, more than 97 percent of births assisted by certified nurse-midwives occur in hospitals; 2 percent in freestanding birth centers; and fewer than 2 percent in homes, according to figures from the National Center for Health Statistics.

Furthermore, in births attended by nurse-midwives and intended to occur at home, only 9.1 percent of women were transferred to the hospital during labor or after birth. Only 1.1 percent of infants were transferred, according to a research summary compiled by the American College of Nurse-Midwives.

Another misconception is that nurse-midwives are involved only with pregnancies and births. But they focus on lifelong health education and care, including family planning and yearly women's health exams.

The American Association of Colleges of Nursing in 2004 endorsed changing the preparation for advanced nursing practice, including nurse-midwifery, from master's degrees to doctorates by 2015.

Nurses who will receive their doctoral degree on May 14 are excited about the profession's future.

"We look at the whole patient. It's us partnering (with the patient)," said Lindsey Wilson, a registered nurse who worked in labor and delivery for five years. "We believe in letting the body do what it's intended to do."

Summer Latta, a registered nurse who had planned to be a family nurse practitioner, changed her career path when "I realized my heart was with women's health. I've worked in labor/delivery for nine years. When the doctoral program for nurse-midwifery got the stamp of approval, I transitioned into it in the summer of 2008.

"I plan to stay here in the state and work in a thriving practice in Dallas/Fort Worth that provides comprehensive care to women of all ages," Latta said. "I'm excited. It's been a long road."

Also receiving her DNP degree will be Carla Morrow, a recipient of the Great 100 Award in the Dallas/Fort Worth area. Each year, 100 professional Registered Nurses are recognized for their contributions to the communities in which they live and practice. They have been nominated by their peers, officials at practice sites, families and patients in their care. More than 15,000 nurses practice in the Metroplex.

About nurse-midwifery:

 Births in the United States attended by certified nurse-midwives or certified midwives have increased by 33 percent since 1996, reaching a high of 317,168 in 2006, the most recent figures available. That accounts for 7.4 percent of all United States births.

 Approximately 11,300 certified nurse-midwives assist with births in the United States, according to the American Midwifery Certification Board.

 About 80 percent of certified nurse-midwives have a master's degree; 5 percent a doctorate.

 Earning a doctoral degree in nurse-midwifery takes about seven years for a full-time student, with four years of that generally required to obtain a bachelor's degree.

 Registered nurses applying for doctoral programs generally are recommended to have work experience as a registered nurse (as well as a degree), but it usually is not required.

 While the history of midwifery goes back thousands of years, it was not until 1955 that the American College of Nurse-Midwives was incorporated. The country's first nurse-midwives began practicing in 1925 in response to the high mortality rate in remote areas of Kentucky.

SOURCES: American College of Nurse-Midwives, American Midwifery Certification Board and Baylor University Louise Herrington School of Nursing

Recognition and Commencement Ceremonies

Louise Herrington School of Nursing students completing their Doctor of Nursing Practice in nurse-widwifery degrees, as well those completing Master of Science degrees in nursing, will be honored at a recognition ceremony at 5:30 p.m. Wednesday, May 12, at Stitch Davis Auditorium, 3500 Gaston Ave. in Dallas.

Formal commencement will be at 2:30 p.m. Friday, May 14, at the Ferrell Center, 1900 S. University Parks Drive in Waco.